Behavioral Health Provider Attitudes and Beliefs about Sexuality and Intimacy: Findings from a Mixed Method Design.

Recovery-oriented services overlook a crucial health domain for persons with severe mental illnesses (SMI): sexuality and intimacy. Though this aspect of social recovery correlates with improved life quality and treatment outcomes, behavioral health (BH) providers avoid such topics. The study's purpose was to obtain an updated snapshot of their attitudes and beliefs about sexuality and intimacy communication. Utilizing a community advisory board, we adapted the Sexual Attitudes and Beliefs Survey (SABS) and distributed it via survey link to a national listserv. We used independent samples t-tests to examine differences on SABS mean scores by gender, age group, educational attainment, and previous training on sexuality and intimacy. We asked open-ended questions and coded responses using content analysis. Participants with more education and previous exposure to training on sexuality and intimacy were more likely to hold open views on communication. Findings offer directions for addressing this neglected aspect of recovery.

Correction to: Transitioning to Person-Centered Care: a Qualitative Study of Provider Perspectives.

The original article misspelled the name of Lauren Jessell. The original article has been corrected.

Building Capacity for Evidence-Based Practice Together.

Social workers are increasingly called to implement evidence-based practices and systematically evaluate efficacy. As healthcare reform magnifies these mandates for a growing population of service users, social work educators are positioned to play important roles in helping organizations build capacity for this work. This article presents two examples of faculty members successfully filling this role; one developed a teaching model for evidence-based practice that synchronized classroom and field continuing education, and the other linked curricular goals with an agency's need for program evaluation. The success of these initiatives identifies opportunities for educators to meet growing needs in health services.

Motivational Interviewing: Creating a Leadership Role for Social Work in the Era of Healthcare Reform.

To better address the needs of individuals with a range of complex health conditions, the Affordable Care Act has shifted the focus from acute care to prevention through behavior change and promoted the integration of physical and behavioral healthcare systems. Central to healthcare reform is delivering person-centered care, which means actively engaging people in their treatment decisions and managing their wellness. Motivational Interviewing (MI) is perhaps the most widely used intervention to promote behavior change. Although MI is utilized across most health disciplines, social workers are uniquely positioned to lead dissemination and on-going training efforts in this area.

Urban adolescent girls' perspectives on multiple partners in the context of the sexual double standard and intimate partner violence.

This article describes the influence of abusive and nonabusive relationship dynamics on the number of sex partners among urban adolescent girls. Focus groups were conducted with 64 sexually active adolescent girls ages 14 to 17 years. General coding and content analyses identified patterns, themes, and salient beliefs. More than one third (37.5%) reported having experienced physical, intimate partner violence; 32.8% had two or more recent sex partners, and 37.5% had ever had a sexually transmitted infection (STI) or HIV. Although some girls in abusive relationships feared retribution if they had more than one partner, others sought additional partners for solace or as an act of resistance. Adolescent HIV/STI prevention programs need to address the influence of gender norms such as the sexual double standard, as well as partner pressure and partner abuse on adolescent decision-making about safer sex, and also promote healthy relationships as integral to advancing HIV/STI risk reduction.

Unwanted unprotected sex: condom coercion by male partners and self-silencing of condom negotiation among adolescent girls.

This exploratory study used the theory of reasoned action and the theory of gender and power to guide elicitation of partner-related impediments to condom use among 64 adolescent girls living in poor urban areas with high rates of HIV and partner abuse. About 53% indicated that they had experienced unwanted, unprotected vaginal sex and 25% indicated that they were unable to discuss condom use with a partner. Novel qualitative findings related to condom coercion, condom sabotage, and self-silencing of condom negotiation are discussed in the context of connecting partner abuse to interpersonal control over condom use. Implications for intervention design are discussed.

A randomized trial of a nursing intervention for HIV disease management among persons with serious mental illness.

OBJECTIVE: The heightened risk of persons with serious mental illness to contract and transmit HIV is recognized as a public health problem. Persons with HIV and mental illness may be at risk for poor treatment adherence, development of treatment-resistant virus, and worse outcomes. The objective of this study was to test the effectiveness of a community-based advanced practice nurse (APN) intervention (PATH, Preventing AIDS Through Health) to promote adherence to HIV and psychiatric treatment regimens. METHODS: Community-dwelling HIV-positive participants with co-occurring serious mental illnesses (N=238) were recruited from community HIV provider agencies from 2004 to 2008 to participate in the randomized controlled trial. Participants in the intervention group (N=128) were assigned an APN who provided community-based care management at a minimum of one visit per week and coordinated clients' medical and mental health care for one year. Viral load and CD4 cell count were evaluated at baseline and 12 months. RESULTS: Longitudinal models for continuous log viral load showed that compared with the control group, the intervention group exhibited a significantly greater reduction in log viral load at 12 months (d=-.361 log 10 copies per milliliter, p<.001). Differences in CD4 counts from baseline to 12 months were not statistically significant. CONCLUSIONS: This project demonstrated the effectiveness of community-based APNs in delivering a tailored intervention to improve outcomes of individuals with HIV and co-occurring serious mental illnesses. Persons with these co-occurring conditions can be successfully treated; with appropriate supportive services, their viral loads can be reduced.

Case managers discovering what recovery means through an HIV prevention intervention.

Following a randomized trial of case manager delivered HIV prevention intervention to persons with severe mental illness (SMI), this study sought to document changes within the service environment and with case managers themselves as a result of their experience and skills training. Utilizing qualitative methods, researchers conducted focus groups and in-depth interviews with 22 case managers and 3 administrators at an urban community mental health center. Beyond confirming previously established barriers to case manager delivery of HIV prevention interventions for persons with SMI, most noteworthy was the finding that case managers were generally unskilled in conducting assessments and tended to focus on "spoiled identity" and illness parts of their consumers. Experimental case managers revealed that they had been transformed by the training experience in a manner permitting them to both understand and work from a recovery model. Implications and directions for further study are discussed.

Elicitation of cognitions related to HIV risk behaviors in persons with mental illnesses: implications for prevention.

OBJECTIVE: An important step in research using the Theory of Reasoned Action and Theory of Planned Behavior (TRA/TPB) is conducting an elicitation process to identify topic and population specific cognitions. This study explored HIV risk behaviors in persons with mental illnesses and introduces findings from focus groups conducted during the development phase of an HIV primary and secondary prevention intervention study. METHODS: Researchers held four focus groups with persons with mental illnesses focused on HIV risks and condom use. RESULTS: Participants discussed sexual side effects of psychotropic medications as a potential cause of both medication non-adherence and HIV risk behaviors. The intersection of these two issues is specific to this population. CONCLUSIONS: We conclude with the recommendation that HIV primary and secondary prevention intervention for persons with mental illnesses must incorporate the promotion of healthy sexuality, including attention to sexual side effects of psychotropic medications.

Rapid assessment of existing HIV prevention programming in a community mental health center.

In preparation for implementation of a comprehensive HIV prevention program in a Community Mental Health Center for persons with mental illness who are also abusing substances, a rapid assessment procedure (RAP) of existing prevention services that may have developed in the setting over time was undertaken at baseline. In addition to an ecological assessment of the availability of HIV-related information that was available on-site, in-depth interviews and focus groups were conducted with Center administrators, direct-care staff, and mental health consumers. Results indicated that responses regarding available services differed depending upon type of respondent, with administration reporting greater availability of preventive programs and educational materials than did direct-care staff or mental health consumers themselves. But overall, formalized training on HIV prevention by case managers is extremely rare. Case managers felt that other providers, such as doctors or nurses, were more appropriate to deliver an HIV prevention intervention.

From principles to practice: a study of implementation of supported housing for psychiatric consumers.

In the post-deinstitutionalization era, supported housing has emerged as a housing and service approach considered most conducive to the goal of consumer empowerment and community integration. Although prior research found beneficial effects of supported housing, little empirical work has been done on identifying the gaps between the principles and practice of supported housing. Using multiple data sources on 27 supported independent living (SIL) programs for psychiatric consumers in a large metropolitan community, this paper examines the extent to which these programs are implemented in accordance with supported housing. Findings suggest consistency with as well as deviation from the supported housing approach in regard to consumer choice, typical and normalized housing, resource accessibility, consumer control and provision of individualized and flexible support. This study suggests methods for assessing housing programs for psychiatric consumers along these domains. Implications for the development of housing programs that promote consumer empowerment and community integration are discussed.